Showing papers in "European Journal of Public Health in 2014"

A balancing act? Work-life balance, health and well-being in European welfare states.

Abstract: © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Unemployment and mental health scarring during the life course

Abstract: There has been little research on the long-term relationship between unemployment experiences and mental health over the life course. This article investigates the relationship between youth unempl ...

The evolution of mental health in Spain during the economic crisis.

Abstract: We analyse how mental health and socioeconomic inequalities in the Spanish population aged 16-64 years have changed between 2006-2007 and 2011-2012. We observed an increase in the prevalence of poor mental health among men (prevalence ratio = 1.15, 95% CI 1.04-1.26], especially among those aged 35-54 years, those with primary and secondary education, those from semi-qualified social classes and among breadwinners. None of these associations remained after adjusting for working status. The relative index of inequality by social class increased for men from 1.02 to 1.08 (P = 0.001). We observed a slight decrease in the prevalence of poor mental health among women (prevalence ratio = 0.92, 95% CI 0.87-0.98), without any significant change in health inequality.

Why is the 'healthy immigrant effect' different between European countries?

Abstract: BACKGROUND: Even if health status of immigrants constitutes an important public health issue, the literature provides contradictory results on the existence of a 'healthy migrant' effect in Europe. This study proposes to explore the heterogeneity of the health gap between migrants and natives across four European countries. DATA AND METHODS: Based on several harmonized national health interview surveys, the association between migratory status and self-assessed health was firstly explored separately in Belgium, France, Spain and Italy. To explore whether differences in health gap between countries reflect differences in health status of immigrants between host countries or whether they are because of differences in health status of natives between host countries, the association between the host country and health was secondly analysed separately among a pooled sample of immigrants and one of natives, controlling for socio-economic status and country of origin. RESULTS: After controlling for socio-economic status, immigrants report a poorer health status than natives in France, Belgium and Spain, whereas they report a better health status than natives in Italy, among both women and men. A North-South gradient in immigrants' health status appears: their health status is better in Italy and in Spain than in France and Belgium. Conversely, health status of natives is poorer in Italy and in Belgium than in France and in Spain. CONCLUSION: Differences in health gap reflect differences in health status of both natives and immigrants between host countries. This suggests differences in health selection at migration and in immigrants' integration between European countries.

Prevalence and risk factors of Internet addiction in high school students

Abstract: Aim: In this study, the prevalence and risk factors of Internet addiction in high school students was investigated. Material and Method : This cross-sectional study was performed in the Mersin Province in 2012. The study sample consisted of students attending high school in the central district of Mersin. The data were summarized by descriptive statistics and compared by a binary logistic regression. Results: Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys ( P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception. Conclusion: According to our study results, the prevalence of Internet addiction was high among high school students. We recommend preventing Internet addiction among adolescents by building a healthy living environment around them, controlling the computer and Internet use, promoting book reading and providing treatment to those with a psychological problem.

Delays in diagnosis and treatment of breast cancer: a multinational analysis

Abstract: Background: Reducing treatment delay improves outcomes in breast cancer. The aim of this study was to determine factors influencing patient- and system-related delays in commencing breast cancer treatment in different countries. Methods: A total of 6588 female breast cancer patients from 12 countries were surveyed. Total delay time was determined as the sum of the patient-related delay time (time between onset of the first symptoms and the first medical visit) and system-related delay time (time between the first medical visit and the start of therapy). Results: The average patient-related delay time and total delay time were 4.7 (range: 3.4–6.2) weeks and 14.4 (range: 11.5–29.4) weeks, respectively. Longer patient-related delay times were associated with distrust and disregard, and shorter patient-related delay times were associated with fear of breast cancer, practicing self-examination, higher education level, being employed, having support from friends and family and living in big cities. The average system-related delay time was 11.1 (range: 8.3–24.7) weeks. Cancer diagnosis made by an oncologist versus another physician, higher education level, older age, family history of female cancers and having a breast lump as the first cancer sign were associated with shorter system-related delay times. Longer patient-related delay times and higher levels of distrust and disregard were predictors of longer system-related delay times. Conclusions: The delay in diagnosis and treatment of breast cancer remains a serious problem. Several psychological and behavioural patient attributes strongly determine both patient-related delay time and system-related delay time, but their strength is different in particular countries.

Health in all policies--from what to how.

Abstract: Already the Ottawa conference for health promotion in 1986 pointed out the importance of environment for our health.1 ‘Make the healthy choice the easy one’ was the famous slogan. But actually much earlier, in the 1800s, Rudolf Virchow emphasized the role of social conditions for public health. Hygienic improvements in environments and social conditions were seen as important measures for controlling the infectious disease epidemics of those times. With the emergence of chronic, non-communicable diseases as major public health problems, early response was clinical treatments. With the identification of their behavioural risk factors, public health work started to pay attention to prevention and to health education of people. But the Ottawa Charter argued that health education alone is insufficient. The role of the social and physical environments was again emphasized for disease prevention and health promotion. The North Karelia Project in Finland and several other projects pioneered the community-based …

Political determinants of health.

Abstract: During the past decade, the idea that health issues need to be brought into the political arena to advance population health has become part of mainstream public health, often with a reference to famous antecedents like Virchow (‘Politics is nothing but medicine at a larger scale’). Empirical evidence of the impact of politics on population health is, however, scarce. To the extent that recent reviews cover the whole field, the total number of publications with empirical data relating political variables to health outcomes is estimated to be less than a few hundred.1,2 For public health professionals to use the political arena effectively, for example, to promote tobacco and alcohol control, to improve access to health services or to tackle health inequalities, they must not only …

Recent research on the mental health of immigrants to Sweden: a literature review

Abstract: The arrival of large numbers of economic migrants and refugees has seen the Swedish immigrant population increase rapidly. Research has shown that immigrants may be more susceptible to mental disorders because of traumatic events prior to immigration and adverse circumstances in their new country. The aim of this literature review is to summarize and interpret recent research on the mental health of immigrants to Sweden. Methods: A systematic search for relevant literature in PubMed was performed on 13 February 2014. Relevant literature was limited to original research articles published between 1 January 1994 and 13 February 2014. Content relating to mental disorders and suicide was reviewed and summarized. Results: Nationwide studies showed increased risks of common mental disorders such as depression, as well as psychotic disorders, in immigrants to Sweden compared to native Swedes. However, the results are complex, with notable differences between different immigrant groups and between males and females. Risk of suicide was increased in some immigrant groups, but decreased in others. There has been little qualitative research on the mental health of immigrants and few intervention studies have targeted immigrants. Conclusion: Immigrants to Sweden are a mixed group with differing, but often increased, risks of mental disorders. Targeted qualitative and intervention studies may facilitate efforts to develop and implement preventive methods for immigrants at high risk of mental ill health, and to tailor treatment to the specific needs of different immigrant groups.

Combining employment and family in Europe: the role of family policies in health

Abstract: Objectives: The objectives of this study were: (i) to analyse the relationship between health status and paid working hours and household composition in the EU-27, and (ii) to examine whether patterns of association differ as a function of family policy typologies and gender. Methods: Cross-sectional study based on data from the 5th European Working Conditions Survey of 2010. The sample included married or cohabiting employees aged 25-64 years from the EU-27 (10,482 men and 8,882 women). The dependent variables were self-perceived health status and psychological well-being. Results: Irrespective of differences in family policy typologies between countries, working long hours was more common among men, and part-time work was more common among women. In Continental and Southern European countries, employment and family demands were associated with poor health status in both sexes, but more consistently among women. In Anglo-Saxon countries, the association was mainly limited to men. Finally, in Nordic and Eastern European countries, employment and family demands were largely unassociated with poor health outcomes in both sexes. Conclusions: The combination of employment and family demands is largely unassociated with health status in countries with dual-earner family policy models, but is associated with poorer health outcomes in countries with market-oriented models, mainly among men. This association is more consistent among women in countries with traditional models, where males are the bread- winners and females are responsible for domestic and care work.

Effect of survey mode on response patterns: comparison of face-to-face and self-administered modes in health surveys.

Abstract: Background: While face-to-face interviews are considered the gold standard of survey modes, self-administered questionnaires are often preferred for cost and convenience. This article examines response patterns in two general population health surveys carried out by face-to-face interview and self-administered questionnaire, respectively. Method: Data derives from a health interview survey in the Region of Southern Denmark (face-to-face interview) and The Danish Health and Morbidity Survey 2010 (self-administered questionnaire). Identical questions were used in both surveys. Data on all individuals were obtained from administrative registers and linked to survey data at individual level. Multiple logistic regression analyses were used to examine the effect of survey mode on response patterns. Results: The non-response rate was higher in the self-administered survey (37.9%) than in the face-to-face interview survey (23.7%). Marital status, ethnic background and highest completed education were associated with non-response in both modes. Furthermore, sex and age were associated with non-response in the self-administered mode. No significant mode effects were observed for indicators related to use of health services, but significant mode effects were observed for indicators related to self-reported health-related quality of life, health behaviour, social relations and morbidity (long-standing illness). Conclusions: The same factors were generally associated with non-response in both modes. Indicators based on factual questions with simple answers categories were overall more comparable according to mode than indicators based on questions that involved more subjective assessments. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection.

Six Steps in Quality Intervention Development (6SQUID)

Abstract: Background Improving the effectiveness of public health interventions relies as much on the attention paid to their design and feasibility as to their evaluation. Yet, compared to the vast literature on how to evaluate interventions, there is little to guide researchers or practitioners on how best to develop such interventions in practical, logical, evidence based ways to maximise likely effectiveness. Existing models for the development of public …

Retirement and a healthy lifestyle: opportunity or pitfall? A narrative review of the literature

Abstract: Background: Retirement is a life-course transition in late adult life that is marked by major changes that may affect healthy lifestyles. Our aim is to give an overview of the current knowledge on changes in smoking, alcohol consumption, physical activity and dietary habits during the transition to retirement. This may provide clues to a better targeting and timing of preventive activities at older age. Methods: Literature search in Medline, Scopus, Embase, PsycInfo, Social SciSearch and SciSearch limited to English-language papers published between 2001 and May 2013. Results of 20 original papers are summarized in a narrative review. Results: Some studies report an increase in alcohol consumption after retirement, whereas others found a decrease or no change at all. Those who retired involuntarily tended to increase their alcohol consumption, whereas retirees who quit voluntarily did not change their alcohol consumption. Leisure-time physical activity seems to increase slightly after retirement, especially moderately intensive physical activity. This increase does not compensate the loss of work-related physical activity such as the work itself or work-related transportation. The studies on changes in smoking and dietary habits were too limited to draw conclusions. Conclusions: The transition to retirement is accompanied with both favourable and unfavourable lifestyle changes, depending on the type of lifestyle, lifestyle indicator and the personal situation of the retiree. The (pre-)retirement period may well offer a suitable opportunity for preventive action, for example in pre-retirement programmes, planning or other retirement-related support.

Stressful life events and the onset of chronic diseases among Australian adults: findings from a longitudinal survey

Abstract: Objectives: This article examines the link between stressful life events and illness by considering both onset and reoccurrence of chronic illnesses. Using longitudinal data, we estimate the extent to which life events increase the likelihood of depression or anxiety, type 2 diabetes, cancer, coronary heart disease, circulatory disease, asthma and emphysema among Australian adults aged 21 years. Methods: Longitudinal data were obtained from the nationally representative Household, Income and Labour Dynamics in Australia panel survey collected at waves 3 (2003), 7 (2007) and 9 (2009). Participants (N = 9222) answered life events questions relating to the preceding 12 months and chronic illnesses lasting (or expected to last for) 6 months. Weighted pooled and random effects logistic regressions were performed, controlling for confounders and previous illness, and also performed on subsamples delineated by reported illnesses in wave 3. Results: Work-related stress (odds ratio (OR) = 1.54, P < 0.001) was positively associated with the onset of depression or anxiety. Personal stress increased the likelihood of the onset of depression or anxiety (OR = 1.70, P < 0.001), type 2 diabetes (OR = 1.47, P < 0.05) and circulatory diseases (OR = 1.72, P < 0.05), while family-related stress increased the likelihood of the onset of heart (OR = 1.32, P < 0.01) and circulatory diseases (OR = 1.32, P < 0.05). Conclusions: Independent of personal characteristics and key health measures (body mass index, hypertension and disability), these findings suggest that work-related, personal and family-related stressful life events contribute to the development and/or course of chronic diseases.

Impact of financial crisis on selected health outcomes in Europe.

Abstract: BACKGROUND: A number of health outcomes were affected by previous financial crises, e.g. suicides, homicides and transport accident mortality. Aim of this study was to analyse the effects of the current financial crisis on selected health outcomes at population level in Europe. METHODS: A mixed approach of ecologic and time trend design was applied, including correlation analysis. For eight countries, data on the economic situation (unemployment rate and economic growth) and health indicators (overall mortality, suicide and transport accident mortality) was drawn from EUROSTAT database for 2000-10. Spearman's rank correlation was applied to analyse the influence of social protection on the association between exposure and outcome variables. RESULTS: The financial crisis had no visible effect on overall mortality in any of the eight countries until 2010. Transport accident mortality decreased in all eight countries, in the range of 18% in Portugal to 52% in Slovenia. In contrast, suicide mortality increased in Germany (+5.3%), Portugal (+5.2%), Czech Republic (+7.6%), Slovakia (+22.7%) and Poland (+19.3%). The effect of unemployment on suicide is higher in countries with lower social spending (Spearman's r = -0.83). DISCUSSION: Clear cause-effect relations could not be established owing to the ecological study design and issues concerning data availability. However, there are clear changes in suicide and transport accident mortality after onset of the crisis, and findings are consistent with previous work. As part of this work, a comprehensive framework was developed, which can be applied to analyse health effects of financial crises in more detail. Language: en

Sleep problems, exercise and obesity and risk of chronic musculoskeletal pain: the Norwegian HUNT study.

Abstract: Background: The objective was to investigate the association between self-reported sleep problems and risk of chronic pain in the low back and neck/shoulders, and whether physical exercise and body mass index (BMI) alter this association. Methods: The study comprised data on 26 896 women and men in the Nord-Trondelag Health Study (Norway) without chronic pain or physical impairment at baseline in 1984-86. Occurrence of chronic pain was assessed at follow-up in 1995-97. A generalized linear model was used to calculate adjusted risk ratios. Results: Sleep problems were dose-dependently associated with risk of pain in the low back and neck/shoulders in both women and men (P < 0.001 both genders). Women and men who reported sleep problems 'sometimes' and 'often/ always' had a higher risk of chronic pain of 23-32% and 51-66%, respectively, than those who reported sleep problems 'never'. Combined analyses showed that persons with sleep problems 'sometimes' and who exercised 1 hour per week had lower risk of chronic pain in the low back (P < 0.04) and neck/shoulders (P < 0.001) than inactive persons with a similar level of sleep problems (P < 0.04). Likewise, persons with BMI <25 kg/cm 2 and sleep problems 'sometimes' had lower risk of chronic pain in the low back (P < 0.001) and neck/shoulders (P < 0.001) than persons with BMI 25 kg/cm 2 and a similar level of sleep problems. Conclusion: Sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain.

Trends and risk groups for smoking during pregnancy in Finland and other Nordic countries

Abstract: Background: Reductions in maternal smoking can prevent pregnancy complications and adverse effects to foetus. Our objective was to study how the prevalence of maternal smoking differs between Nordic countries, and to identify target groups for smoking-cessation interventions. Methods: Information on maternal smoking and background factors was requested from the Nordic countries (the Danish National Board of Health, the Finnish National Institute for Health and Welfare, the Public Health Institute in Iceland, the Norwegian Institute of Public Health and the Swedish National Board of Health and Welfare). Data on maternal smoking were received from 1991 to 2010 in Denmark, 1987 to 2010 in Finland, 1999 to 2009 in Norway and 1983 to 2008 in Sweden. Trends in smoking were studied by using test for relative proportion. Results: The prevalence of maternal smoking in early pregnancy has declined in the countries during the past 20 years (Denmark: from 30.6 to 12.5%; Norway: 20.6 to 16.5% and Sweden: 31.4 to 6.9%), except in Finland (a steady prevalence at 15%). The highest rates of smoking in early pregnancy were among teenagers (24% in Sweden and 49% in Finland and Norway). Single women were 2–3 times more likely to smoke than married women. The women in the lowest socioeconomic group were 6–7 times more likely to smoke than women in the highest group in Finland and Norway. Conclusion: Maternal smoking and its trends differed between the Nordic countries. The highest smoking rates during pregnancy were observed among teenagers, single women and women with a low socioeconomic position.

Equity impact of European individual-level smoking cessation interventions to reduce smoking in adults: a systematic review

Abstract: Background: Smoking is the leading cause of health inequalities in Europe. Adults from lower socioeconomic status (SES) groups are more likely to smoke and less likely to quit than adults from higher SES groups. Smoking cessation support is an important element of tobacco control; however, the equity impact of individual-level cessation support is uncertain. Methods: Systematic review of individual-level smoking cessation interventions delivered in European countries, reporting a smoking cessation outcome (quit) in adults of lower compared with higher SES. Equity impact was assessed as positive (reduced inequality), neutral (no difference by SES), negative (increased inequality) or unclear. Results: Twenty-nine studies were included using different types of support: behavioural and pharmacological (17); behavioural only (11), including specialist (5), brief advice (1), mass media (2), text-based (1) and Internet-based (2); and pharmacological only (1). The distribution of equity effects on quitting was 10 neutral, 18 negative and 1 unclear. Two national studies of UK National Health Service (NHS) stop-smoking services showed overall positive equity impact on smoking prevalence. The evidence suggests that UK NHS services that target low-SES smokers achieve a relatively higher service uptake among low-SES smokers, which can compensate for their lower quit rates. Conclusions: Untargeted smoking cessation interventions in Europe may have contributed to reducing adult smoking but are, on balance, likely to have increased inequalities in smoking. However, UK NHS stop-smoking services appear to reduce inequalities in smoking through increased relative reach through targeting services to low-SES smokers. More research is needed to strengthen the evidence-base for reducing smoking inequalities.

Economic impact of adult obesity on health systems: a systematic review.

Abstract: Background: Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies. Methods: A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummond’s checklist. Results: Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium–high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective. Conclusion: The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health

Abstract: Background: Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. Methods : Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey ( n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. Findings : There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64–7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02–5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08–7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15–9.58) or illegal (aOR = 17.34, 95%CI: 1.96–153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02–0.48). Conclusion : There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study

Abstract: Background: Complaints of vertigo and dizziness are common in primary care in the aged. They can be caused by distinct vestibular disorders, but can also be a symptom in other conditions like non-vestibular sensory loss, vascular encephalopathy or anxiety. The aim of this study was to investigate the specific contribution of vertigo and dizziness to the total burden of disability in aged persons when controlling for the presence of other health conditions. Methods: Data originate from the MONICA/KORA study, a population-based cohort. Survivors of the original cohorts who were 65 years and older were examined by telephone interview in 2009. Disability was assessed with the Health Assessment Questionnaire. Logistic regression was used to adjust for potential confounders and additive regression to estimate the contribution of vertigo and dizziness to disability prevalence. Results: Adjusted for age, sex and other chronic conditions, vertigo and dizziness were associated with disability (odds ratio 1.66, 95% confidence intervals 1.40-1.98). In both men and women between 65 and 79 years, vertigo and dizziness were among the strongest contributors to the burden of disability with a prevalence of 10.5% (6.6 to 15.1) in men and 9.0% (5.7 to 13.0) in women. In men, this effect is stable across all age-groups, whereas it decreases with age in women. Conclusions: Vertigo and dizziness independently and relevantly contribute to population-attributable disability in the aged. They are not inevitable consequences of ageing but arise from distinct disease entities. Careful management of vertigo and dizziness might increase population health and reduce disability.

Cultures of evidence across policy sectors: systematic review of qualitative evidence.

Abstract: Background: It is important to understand the decision-making process, and the role of research evidence within it, across sectors other than health, as interventions delivered within these sectors may have substantial impacts on public health and health inequalities. Methods: Systematic review of qualitative evidence. Twenty-eight databases covering a range of sectors were searched. Studies were eligible if they included local decision-makers in a policy field relevant to the social determinants of health (including housing, transport, urban planning and regeneration, crime, licensing or trading standards), were conducted in a high-income country, and reported primary qualitative data on perceptions of research evidence. Study quality was assessed and a thematic synthesis undertaken. Results: Sixteen studies were included, most using interview designs, and most focusing on planning or transport policy. Several factors are seen to influence decision-makers’ views of evidence, including practical factors such as resources or organizational support; the credibility of the evidence; its relevance or applicability to practice; considerations of political support or feasibility; and legislative constraints. There are limited data on how evidence is used: it is sometimes used to not only support decision-making, but also to lend legitimacy to decisions that have already been made. Conclusion: Although cultures of evidence in non-health sectors are similar to those in health in some ways, there are some key differences, particularly as regards the political context of decision-making. Intersectoral public health research could benefit from taking into account non-health decision makers’ needs and preferences, particularly around relevance and political feasibility.

Validation of the SDQ in a multi-ethnic population of young children

Abstract: Background: The Strengths and Difficulties Questionnaire (SDQ) is a valuable screening tool for identifying psychosocial problems. Its performance in a multi-ethnic society, common to many paediatric health care workers, has not been investigated. Because it is important that screening instruments are valid and reliable for all ethnic groups within one society, we examined differences in the SDQ’s psychometric properties in a multi-ethnic society. Methods: The SDQ parent ( n = 8114) and teacher form ( n = 9355) were completed as part of a preventive health check for children aged 5–6 years of Dutch and non-Dutch ethnic backgrounds. The Child Behaviour Checklist (CBCL)/Teacher Report Form (TRF) was administered to a subsample. Results: Factor analysis of the parent-rated SDQ showed different rating patterns for two of the five subscales for non-Dutch children as compared with Dutch children. Cronbach’s alpha for the total difficulties score varied by ethnic group (0.73–0.78 parent-rated SDQ, 0.80–0.83 teacher-rated SDQ), and coefficients were generally smaller for non-Dutch than for Dutch children ( P < 0.05). Alpha coefficients for subscales varied between 0.31–0.85 for ethnic groups. Inter-rater correlations between parents and teachers for the total difficulties score varied between 0.20–0.41 between ethnic groups and were larger for Dutch than for non-Dutch children ( P < 0.05). Concurrent validity was acceptable for most scales and most ethnic groups. Conclusion: The total difficulties score of the parent- and teacher-rated SDQ is valid and reliable for different ethnic groups within Dutch society. However, there are differences in reliability and validity of the subscales, which makes interpretation of the subscales difficult for certain ethnic groups.

Trends in health systems in the former Soviet countries

Abstract: Background The post-Soviet countries had very similar starting points after gaining independence in 1991, yet embarked on widely varying developments. More than two decades since the collapse of the Soviet Union, it is time to review the progress the post-Soviet countries have made in reforming their health systems, and the lessons this experience offers to other countries. This abstract presents findings of a study undertaken by the European …

Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey

Abstract: Background: Unmet health care needs are associated with negative health outcomes, yet there is a paucity of data on this problem among older people. Objective: To identify unmet health care needs and associated factors among older people in France. Methods: This is a cross-sectional population study of people aged 70 years or older in which 2350 respondents were interviewed in 2008–10. During a standardized interview, a nurse examined health problems, functional abilities and use of health care resources. Unmet health care needs were defined as situations in which a participant needed health care and did not receive it. Results: The mean age was 83.2 ± 7.4 years. Almost all participants reporting a chronic disease (98.6%) had consulted a physician in the previous 6 months. Unmet health care needs were found in 23.0% of the sample and mainly consisted of lack of dental care (prevalence of 17.7%), followed by lack of management of visual or hearing impairments (prevalence of 4.4% and 3.1%, respectively). Age was the main factor associated with unmet health care needs [compared with people aged 70–79: odds ratio80–89 years = 2.26 (1.70–3.03), odds ratio90 years and over = 3.85 (2.71–5.45)]. Other associated factors were regular smoking, homebound status, poor socioeconomic conditions, depression, limitations in instrumental activities of daily living and low medical density. Conclusion: Unmet health care needs affect almost one-quarter of older people in France. Efforts should be made to improve oral health and develop home care, especially for the oldest-olds.

In search for a public health leadership competency framework to support leadership curriculum-a consensus study

Abstract: Background: Competency-based education is increasingly popular, especially in the area of continuing professional development. Many competency frameworks have been developed; however, few address leadership competencies for European public health professionals. The aim of this study was to develop a public health leadership competency framework to inform a leadership curriculum for public health professionals. The framework was developed as part of the Leaders for European Public Health project—supported by the EU Lifelong Learning Programme. Methods: The study was carried out in three phases: a literature review, consensus development panel and Delphi survey. The public health leadership competency framework was initially developed from a literature review. A preliminary list of competencies was submitted to a panel of experts. Two consensus development panels were held to evaluate and make changes to the initial draft competency framework. Then two rounds of a Delphi survey were carried out in an effort to reach consensus. Both surveys were presented through Survey Monkey to members of the Association of the Schools of Public Health in the European Region Working Group on Innovation in Public Health Teaching and Education. Results: The framework was developed consisting of 52 competencies organized into eight domains: Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership, Organizational Learning and Development and Ethics and Professionalism. Conclusion: The framework can serve as a useful tool in identifying gaps in knowledge and skills, and shaping competency-based continuing professional development leadership curricula for public health professionals in Europe.

The World Health Organization’s Health Promoting Schools Framework: A Cochrane Systematic Review and Meta Analysis

Abstract: Background Children spend almost half their waking hours in educational settings. Schools therefore provide an important opportunity to promote children’s health and happiness, thereby enabling them to learn better and remain in good health in later life. The World Health Organization’s Health Promoting Schools (HPS) framework is an holistic approach to promoting health and educational attainment. The effectiveness of this approach has …

Trends of overweight and obesity, physical activity and sedentary behaviour in Czech schoolchildren: HBSC study.

Abstract: Background: The decline of physical activity (PA) and the increased prevalence of overweight and obese children have been discussed worldwide. This study assessed the trends in the prevalence of overweight and obesity, PA and sedentary behaviour in Czech school-aged children. Methods: A cross-sectional questionnaire from the Czech Republic was administered in cycles in 2002, 2006 and 2010 under the Health Behaviour in School-Aged Children (HBSC) study. In the study, 14 219 children aged 11–15 years participated. Results: In comparison with 2002, there is a significant increase ( P 2 h being spent sitting by a TV or PC and consuming fruit and vegetables (negative associations) or sweets and sweetened lemonades (positive associations). Conclusions: An increasing percentage of obese or overweight children, increased sedentary time and a decline or stagnation of the proportion of children meeting recommendations for PA were found among Czech schoolchildren. Future research should evaluate PA recommendations with respect to gender, age and effective intervention approach to reduce the obesity incidence in childhood.

The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context

Abstract: Background: The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states. Methods: Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context. Results: The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants’ perspective are identified as future research areas. Conclusions: Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction.

Consanguinity and genetic diseases in North Africa and immigrants to Europe.

Abstract: Endemic diseases are caused by environmental and genetic factors. While in this special issue several chapters deal with environmental factors, including infections, the present focus is on genetic causes of disease clustering due to inbreeding and recessive disease mechanisms. Consanguinity is implying sharing of genetic heritage because of marriage between close relatives originating from a common ancestor. With limited natural selection, recessive genes may become more frequent in an inbred compared with an outbred population. Consanguinity is common in North Africa (NA), and the estimates range from 40 to 49% of all marriages in Tunisia and 29-33% in Morocco. As a consequence, recessive disorders are common in the NA region, and we give some examples. Thalassaemia and sickle cell disease/anaemia constitute the most common inherited recessive disorders globally and they are common in NA, but with immigration they have spread to Europe and to other parts of the world. Another example is familial Mediterranean fever, which is common in the Eastern Mediterranean area. With immigrantion from that area to Sweden, it has become the most common hereditary autoinflammatory disease in that country, and there is no evidence that any native Swede would have been diagnosed with this disease. The examples discussed in this chapter show that the historic movement of populations and current immigration are influencing the concept of 'endemic' disease.